摘要
目的 探讨骨代谢生化标志物对经皮椎体后凸成形术(PKP)术后邻近椎体再骨折的预判作用。方法 将163例行PKP治疗的骨质疏松性椎体压缩骨折(OVCF)患者按照术前骨代谢生化标志物[β胶原降解产物(β-CTX)和Ⅰ型胶原氨基端前肽(PINP)]测量值的正常与否分为低骨转换组(β-CTX和PINP测量值均正常,78例)与高骨转换组(β-CTX测量值明显升高且PINP测量值正常,85例),因患者围手术期均拒绝接受系统抗骨质疏松治疗,故只予口服基础补充剂。比较两组术前资料及术后邻近椎体再骨折累计发生率。结果 患者均获得随访,时间24~36个月。(1)术前一般资料:体重指数、合并症情况、腰椎骨密度T值、PINP两组比较差异均无统计学意义(P>0.05);年龄低骨转换组显著大于高骨转换组(P<0.01);β-CTX高骨转换组明显高于低骨转换组(P<0.01)。(2)术后邻近椎体再骨折累计发生率:术后3、6、12、18个月两组比较差异均无统计学意义(P>0.05);术后24个月及末次随访时高骨转换组均明显高于低骨转换组(P<0.05)。结论 骨代谢生化标志物可作为PKP术后邻近椎体再骨折的重要预判指标,临床上需对OVCF患者进行抑制骨吸收、促进骨形成的系统性抗骨质疏松治疗,以减少术后邻近椎体再骨折的发生。
Objective To investigate the predictive role of bone metabolism markers for adjacent vertebral refracture after percutaneous kyphoplasty(PKP).Methods According to whether the measured value of the preoperative biochemical markers of bone metabolism[β-collagen degradation product(β-CTX)and typeⅠcollagen amino-terminal propeptide(PINP)]were normal or not,the 163 patients with osteoporotic vertebral compression fractures(OVCFs)who underwent PKP surgery were divided into low bone turnover group(the measured vaule ofβ-CTX and PINP were normal,78 cases)and high bone turnover group(the measured vaule ofβ-CTX was signifantly increased,and the measured vaule of PINP was normal,85 cases).Because the patients refused to receive systemic anti-osteoporosis treatment during the perioperative period,they were only given basic oral supplements.The preoperative general data and the cumulative occurrence rate of refracture of adjacent vertebrae were compared between the two groups.Results All patients were followed up for 24~36 months.①Preoperative general information:body mass index,complications,T value of lumbar bone mineral density,PINP:there were no statistical differences between the two groups(P>0.05);age:the low bone turnover group was significantly larger than the high bone turnover group(P<0.01);β-CTX:the high bone turnover group was significantly higher than the low turnover group(P<0.01).②The accumulated incidence rate of refractures of adjacent vertebrae:there was no statistical difference between the two groups at 3,6,12,and 18 months after operation(P>0.05);at postoperative 24 months and last follow-up,the high bone turnover group was significantly higher than that of the low bone turnover group(P<0.05).Conclusions Biochemical markers of bone metabolism can be used as an important indicator for predicting vertebral refracture after PKP.Clinically,systemic anti-osteoporosis therapy is necessary to inhibits bone resorption and promotes bone formation in patients with OVCFs in order to reduce the occurrence of postoperative adjacent vertebral fractures.
作者
陈飞
陈强
徐志刚
肖丽云
邱水强
CHEN Fei;CHEN Qiang;XU Zhi-gang;XIAO Li-yun;QIU Shui-qiang(Dept of Orthopaedics,Sijing Hospital of Songjiang District of Shanghai,Shanghai 201434,China;Dept of Orthopaedics,Jiangwan Hospital of Hongkou District of Shanghai,the Hospital Affiliated of Shanghai Univerysity of Medical&Health Sciences,Shanghai 200434,China)
出处
《临床骨科杂志》
2023年第4期470-474,共5页
Journal of Clinical Orthopaedics
基金
上海市虹口区卫生健康委员会医学科研课题(编号:虹卫1902-17)。
关键词
骨代谢生化标志物
骨质疏松
椎体骨折
经皮椎体后凸成形术
再骨折
biochemical markers of bone metabolism
osteoporosis
vertebral fractures
percutaneous kyphoplasty
refractures
